中医疗法对溃疡性结肠炎患者肠道菌群变化的网状meta分析

Network meta-analysis of the traditional Chinese medicine therapy on intestinal flora of patients with ulcerative colitis

目的系统评价中医疗法对溃疡性结肠炎患者肠道菌群的影响。方法计算机检索三大英文数据库(PubMed、Embase、Cochrance Library)和四大中文数据库(CNKI、WanFang、CBM、VIP),纳入中医疗法治疗溃疡性结肠炎的临床随机对照试验(RCT),检索时限均为建库至2021年12月15日。由2位研究者独立筛选文献、提取数据和偏倚风险评价,数据分析采用Stata 15.1软件。结果共纳入33个RCT,共计2597例患者,涉及9种治疗措施,包括西药、中药口服、中药灌肠、中药口服+西药、中药灌肠+西药、中药口服+中药灌肠+西药、中药口服+针灸、中药口服+中药灌肠、西药+中药口服+针灸。数据分析显示,中药口服+针灸疗法在临床有效率、改善双歧杆菌、乳酸菌、大肠埃希菌含量方面效果最佳,中药口服+中药灌肠+西药疗法在降低肠球菌的含量方面具有最佳疗效。结论通过既有证据可知,中医疗法在有效率、改善患者肠道菌群方面具有一定优势,中药口服+针灸疗法在治疗溃疡性结肠炎中成为最优选择的可能性最大。此外,研究结论依然需要大量设计合理、高质量且方法适宜的RCT予以证实。

Objective To systematically evaluate the effect of traditional Chinese medicine therapy on intestinal flora of patients with ulcerative colitis.Methods The literature search was conducted in three English databases(PubMed,Embase and Cochrane Library)and four Chinese databases(CNKI,WanFang,CBM and VIP),the randomized controlled trial(RCT)on ulcerative colitis were retrieved in the period from the date of database establishment to December 15,2021.Two investigators independently screened the literature,extracted data and assessed the risk of bias,using Stata 15.1 software for data analysis.Results A total of 33 RCTs were finally included,with a total sample size of 2597 cases.There were 9 kinds of treatment measures involved,including Western medicine,oral Chinese medicine,enema of Chinese medicine,oral Chinese medicine+Western medicine,enema of Chinese medicine+Western medicine,oral Chinese medicine+enema of Chinese medicine+Western medicine,oral Chinese medicine+acupuncture and moxibustion,oral Chinese medicine+enema of Chinese medicine,oral Western medicine+oral Chinese medicine+acupuncture and moxibustion.Data analysis showed that oral Chinese medicine+acupuncture and moxibustion therapy had the best effect in clinical efficiency,improving the content of bifidobacteria,lactic acid bacteria and Escherichia coli,and oral Chinese medicine+enema of Chinese medicine+Western medicine therapy had the best effect in reducing the content of enterococcus.Conclusion It can be seen from the existing evidence that Chinese medicine therapy has certain advantages in terms of efficiency and improvement of patients'intestinal flora,and oral Chinese medicine+acupuncture and moxibustion therapy is the most likely to become the best choice in the treatment of ulcerative colitis.In addition,the research conclusion still needs to be confirmed by a large number of RCTs with reasonable design,high quality and appropriate methods.